Asbestos project notification form for 225 Rector Place

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler DJ Martinez NYS DEC Permit # NJ 344 Tel.# (210) 656-8889

Disposal Site(s) Meadowfill Landfill, Box 68 Bridgeport Wv/ / Greenndge Reclamation Road 1 Box 716 Scottsdale, P,

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement I) ❑✓ Other (Describe) Asbestos Abatement

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation ❑ Repair 0 Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application 'fl I A/+A11f%L1C AC ACATC&ICAIT

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED SQUARE LINEAR (e.g. running cable, installing n9 fire sP~nklers, (e.9~ entire, east wing. room ak, (e.g. Pipe lagging, ng. plenum 99 n9. ceiling, boiler room, lobby, etc) ducts, storoge tanks, dedcing, etc.) FEET FEET removing and replaang boilers. etc.)

Pool Roo' Entire Roof 9,000 Cleanup of WTC Debris

31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. I am familiar with Federal, State and NYC laws and regulations applicable to asbestos related work.

ATC Associates Hazardous Elimination Corp Hazardous Elimination Corp Name of Air Monitor P nt Name bestos Contra P' me of App' other than Owner)

Si ature Signature Signature

--T/I io/t Date Date Date

32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance of the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. Peter Hoyle (Agent for Owner) Signature Date Print Name of Owner

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

Any modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through the performance of work in incremental or piecemeal fashion. ACP7 212001

NYC-WTC-000114093